title: Selective axillary dissection after axillary reverse mapping to prevent breast-cancer-related lymphoedema.
abstract: BACKGROUND
  It has recently been reported that, using axillary reverse mapping (ARM), the lymphatics from the arm can be spared to reduce the incidence of breast-cancer-related lymphoedema (BCRL). The aim of this study was to assess the feasibility of selective axillary dissection (SAD) after using ARM and partially preserving arm drainage, and to assess the occurrence of BCRL.
  
  
  METHODS
  Using a radioisotope and lymphoscintigraphy, ARM was performed in 60 patients scheduled for SAD, who were subsequently divided for the purpose of comparing the BCRL rates into: group A, comprising 45 patients who successfully underwent SAD with a residual lymphatic hot spot; and group B with 15 whose hot nodes were removed as is normally the case during complete axillary lymph node dissection (ALND).
  
  
  RESULTS
  SAD was feasible in 75% of the 60 patients. SAD was completed successfully in 19 of the first 30 patients, and in 26 of the second 30 patients (p = 0.072). The median follow-up was 16 months (6-36), during which 9 patients developed a BCRL, 4 in group A (9%) and 5 in group B (33%); p = 0.035. None of the patients had nodal relapses during the follow-up.
  
  
  CONCLUSIONS
  Using a radioisotope enables an effective and safe SAD in a large proportion of patients. There was evidence of a trend to suggest a learning curve. The rate of BCRL after SAD was less than one third of the rate recorded after ALND, a result that should encourage the development of the former technique.
authors.affiliation: Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: massimiliano.gennaro@istitutotumori.mi.it.
authors.forename: M
authors.initials: M
authors.lastname: Gennaro
authors.forename: M
authors.initials: M
authors.lastname: Maccauro
authors.forename: C
authors.initials: C
authors.lastname: Sigari
authors.forename: P
authors.initials: P
authors.lastname: Casalini
authors.forename: L
authors.initials: L
authors.lastname: Bedodi
authors.forename: A R
authors.initials: AR
authors.lastname: Conti
authors.forename: A
authors.initials: A
authors.lastname: Caraceni
authors.forename: E
authors.initials: E
authors.lastname: Bombardieri
mesh_terms: D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control*; D061305:Lymphoscintigraphy; D059351:Organ Sparing Treatments; D019275:Radiopharmaceuticals; D013667:Technetium
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium
keywords: Axillary reverse mapping; Breast cancer; Prevention of lymphoedema; Selective axillary dissection